16.Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the events complained about had a negative effect which the organisation has not put right. Having done this, we cannot link the events complained about with the negative impact Mr A has claimed.
17.Mr A is unhappy that the Trust misplaced his referral for an ultrasound guided aspiration and a steroid injection in his knee. He explained that in December 2021, the Trust told him the maximum wait time on the referral was four months.
18.Mr A explained that when he was chasing the Trust for an update, he was told he was still on the waiting list. Mr A tells us that in June 2022, the Trust told him his referral had been misplaced and scheduled an appointment for him in August 2022. Mr A says that during the time he was waiting for his appointment, he was in significant pain and whilst on a family visit in Bulgaria, he had to pay for emergency surgery on his knee.
19.We are very sorry to hear how these events impacted Mr A and acknowledge the pain he was in whilst waiting for his appointment at the Trust.
20.In its complaint response, the Trust acknowledged that the referral made in December 2021 was misplaced in its system and apologised to Mr A for any inconvenience this caused him.
21.The relevant NHS guidance on waiting times says:
‘The maximum waiting time for non-urgent, consultant-led treatments is 18 weeks from the day your appointment is booked through the NHS e-Referral Service, or when the hospital or service receives your referral letter.’
22.Mr A was given a scheduled appointment for 26 August 2022, which is approximately 34 weeks after the referral was requested in December 2021. Guidance suggests that Mr A should have been waiting no more than 18 weeks for an appointment, which means he should have been given appointment no later than 5 May 2022. This is a delay of approximately 16 weeks. We are sorry that this happened, and we consider this 16-week delay could have been avoided if the referral was not misplaced in the Trust’s system.
23.Mr A says that whilst he was in Bulgaria at the start of August 2022, he attended the hospital due to symptoms with his knee. He explained that this visit was not planned, and he had to undergo emergency surgery on his knee which he paid around £1,900 for. Mr A feels this could have been avoided if there were no unnecessary delays with his appointment at the Trust. Following his surgery in Bulgaria, Mr A contacted the Trust and cancelled the appointment scheduled for August 2022 as it was no longer required.
24.The records from the clinic in Bulgaria state that following an MRI scan, Mr A was diagnosed with synovitis, plica syndrome and a baker’s cyst. The records show a recommendation of surgical treatment (urgent arthroscopic surgery) given the condition of Mr A’s knee joint.
25.We understand the key motivation for Mr A bringing his complaint to us is to recover the £1,900 he paid for his procedure in Bulgaria.
26.Our adviser explained that the diagnoses Mr A received in Bulgaria (synovitis, plica syndrome and a baker’s cyst) do not normally require any urgent surgery. Our adviser said that surgery can be considered in refractory cases which do not respond to physiotherapy or injection treatment. Given that the surgery in Bulgaria happened prior to the scheduled appointment at the Trust, we cannot know whether the intended injection treatment at the Trust would have been effective or not.
27.Our adviser said that the delay with treatment at the Trust may have led to increased pain and swelling in Mr A’s knee, however urgent surgery would not be generally needed for his symptoms and treatment with analgesia or injection could have been considered.
28.Based on the evidence we have received, we do not consider we are able to link the delay with the referral at the Trust to Mr A paying for emergency surgery in Bulgaria. We do however acknowledge the delay was unacceptable and we are sorry that this happened. The delay with the referral and subsequent appointment offered to Mr A clearly falls outside of what is expected in the relevant NHS guidance.
29.Our principles for remedy say:
‘There are no automatic or routine remedies for injustice or hardship resulting from maladministration or poor service. Remedies may be financial or non-financial.
An appropriate range of remedies will include:
• an apology, explanation, and acknowledgement of responsibility
• remedial action, which may include reviewing or changing a decision on the service given to an individual complainant; revising published material; revising procedures to prevent the same thing happening again; training or supervising staff; or any combination of these • financial compensation for direct or indirect financial loss, loss of opportunity, inconvenience, distress, or any combination of these.
30.In its complaint response, the Trust acknowledged it had misplaced the referral and apologised to Mr A for this. It also said that it has taken steps to improve its service to prevent the same things happening again. The Trust explained that it has implemented a new system where additional clerical staff are copied into referral requests which will ensure better tracking and management of appointments.
31.The Trust has acknowledged responsibility for the delay, apologised and taken steps to improve its service as a result of Mr A’s complaint. We do consider these actions to be appropriate and in line with our principles for remedy. These actions are a direct result of Mr A making a complaint; therefore we thank him for raising his concerns.
32.In summary, we are very sorry to learn of the delays with Mr A’s appointment at the Trust. We have considered all the evidence and conclude that we are unable to link the delay with Mr A’s appointment and him paying £1,900 for surgery in Bulgaria, given the diagnoses he received do not normally require urgent surgery. Additionally, government guidance for travel to Bulgaria advises people to have appropriate insurance before travelling. If Mr A had this in place, it is likely this would have covered any necessary, urgent surgery. For these reasons, we shall not consider this complaint further. We thank Mr A for taking the time to make his complaint as this has directly led to the Trust implementing service improvements. We acknowledge our decision may be disappointing to Mr A and we apologise if this causes him any upset or distress.